Pulmonary rehabilitation has become increasingly well established as a standard of care for patients with chronic lung diseases. Despite the expanding body of scientific evidence demonstrating benefits of such programs, there are several important issues that need further investigation. First, few of the published studies have long-term follow-up beyond six months. The value of pulmonary rehabilitation will be limited unless the effects can be captured and quantified over longer periods of time. Second, the literature does not clearly identify the relationship of physiologic and other symptom or health status measures such as health related quality of life (HRQOL) as outcome measures. Third, the quality-adjusted life year (QALY) concept is becoming important in medical and health services research. However, there are no studies that systematically measure QALYs over time in patients with chronic lung disease. This proposal will provide important information about long-term outcomes in pulmonary rehabilitation, incorporating analyses with HRQOL and QALY data. The first phase of this study will compare and contrast general and disease-specific measures obtained as part of an existing clinical trial of maintenance therapy after pulmonary rehabilitation in a cohort of patients with chronic obstructive pulmonary disease. The second phase will obtain new data from a 5-7 year follow-up of this same cohort in order to evaluate long-term: (a) changes in HRQOL, spirometry and survival; and (b) predictors of survival and QALYs.